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Several newspapers have reported that many shop-bought soups contain very high levels of salt. The Daily Mail reported that some soups can have as much salt as ‘16 bags of crisps’. The Daily Express, said that one particular takeaway soup from a high-street food chain contains more than an adult’s entire recommended daily dose.

The news reports are based on an investigation into salt levels in soups sold in the UK. The research was carried out by Consensus Action on Salt & Health (CASH), an independent group of scientists that wants to bring about a reduction in the high levels of salt in processed foods and to educate the public about the dangers of too much salt.

CASH found that some soups contained particularly high levels of salt, for instance, the ‘Very Big Soup Bold Thai Green Chicken Curry’ from Eat contained 8.07grams, more than the 6g recommended total daily amount for adults. Overall, 99% of the surveyed products contain more salt per portion than a packet of crisps and one in four of the surveyed soups still fail to meet the 2010 FSA voluntary targets.

As a CASH spokesperson said: “This survey shows huge amounts of salt can be hidden in seemingly healthy choices.” There are ways to limit your salt intake, read the advice below or click on the links to the right.

 

What is CASH?

Consensus Action on Salt & Health (CASH) is a specialist group of scientists and medical professionals that is concerned with salt and its effects on health. The group was set up in 1996 with the aim of working to reach a consensus with the food industry and Government over the harms of a high salt diet. It aims to bring about a reduction in salt levels in processed foods, as well as guiding people to reduce the amount of salt that they add to their diet.

 

What has CASH said?

CASH has carried out an investigation (Dec 2009 to Feb 2010) into the salt levels in soups sold in the UK. Through packaging and online information it surveyed the salt contained in 575 ready-to-eat soups. It looked at soups in cans and cartons, and chilled, branded and supermarket own-label soups, and soups sold over-the-counter in high-street food outlets such as Eat, Pret A Manger, and Caffè Nero.

 

What were the ‘worst’ soups for salt levels?

The ‘worst’ products in terms of highest salt levels per portion (only the saltiest soups for each group surveyed are presented here):

Cafe soups

• Eat Bold Thai Green Chicken Curry (8.07g per portion),
• Eat Bold French Onion (7.5g) and
• Eat Bold Toulouse Sausage, Butter Bean & Lentil (7.23g).

All of these were from Eat’s ‘Very Big Soup’ range.

Those with the highest levels in standard portion sizes included:

• Caffè Nero Organic Carrot & Coriander (3.6g),
• Pret A Manger Lentil & Bacon (3.39g),
• Pret Classic Tomato Soup (3.1g), and
• Eat Bold Thai Green Chicken Curry (2.82g).

Supermarket fresh soups

• New Covent Garden Food Co Scotch Broth (2.4g),
• Marks & Spencer King Prawn Noodle Soup (2.4g),
• The Yorkshire Provender Onion Soup with Hambleton Ale and Mustard (2.31g), and
• Marks & Spencer Simply Fuller Longer Meatball Minestrone (2.3g).

Ready-to-serve soups

• Batchelors Soupfulls Classic Beef & Vegetable (3.0g),
• Batchelors Creamy Chicken Potato & Mushroom (2.6g),
• Heinz Taste of Home Lancashire Lamb Hotpot (2.6g), and
• Heinz Taste of Home Steak & Guinness Soup (2.6g).

 

What were the ‘best’ soups?

The ‘best’ soups in terms of lowest salt levels per portion (only the least saltiest soups for each group surveyed are presented here):

Cafe soups

• Pret A Manger’s Malaysian Chicken (1.0g),
• Winter Vegetable Soup (1.16g),
• Caffè Nero’s Organic Leek & Potato (1.2g), and 
• Eat’s Simple Garden Vegetable (1.23g).

Supermarket fresh soups

• Tideford Organic Moroccan Vegetable (0.44g),
• Asda Extra Special Spiced Moroccan Style Soup (0.5g),
• Sainsbury’s Tomato & Basil (0.75g),
• Sainsbury’s Carrot & Coriander (0.75g), and
• Sainsbury’s Lentil & Red Pepper soups (0.75g), and
• Asda Extra Special Tomato and Basil (0.75g).

Ready-to-serve soups

• Morrisons Chicken Noodle Soup (0.5g),
• Asda Good For You Tomato & Basil Soup (0.5g),
• Tesco Light Choices Carrot & Coriander (0.5g), and
• Sainsbury’s Cream of Tomato & Red Pepper Soup (0.5g).

 

What did CASH conclude?

CASH says that high-street cafes are some of the worst offenders for high salt levels, with a total of 10 products from Eat containing more than the 6g/day salt recommendation for adults. The Eat Very Big Soup Bold Thai Green Chicken Curry contains nearly the same amount of salt as three Big Mac and fries.

• Overall, 99% of the surveyed products contain more salt per portion than a packet of crisps.
• One in four of the surveyed soups still fails to meet the 2010 FSA voluntary targets.
• Only 6% of soups would be eligible to meet the ‘green traffic light’ labelling system.
• In total, 23 supermarket products contain 2g of salt or greater per portion, with 18 of these coming from leading brands including Heinz, New Covent Garden Food Co and Batchelors. Although there has been a 17% reduction of salt per 100g soup in the ready-to-eat ranges since CASH last surveyed soups in 2007, there is still a long way to go to meet the salt reduction targets.
• The supermarkets’ own brands meet 2010 targets in 93% of cases, while the branded products are trailing, with only 66% meeting targets.

Hannah Brinsden, who carried out the research for CASH, summarised: “In general, the cafe style takeaway soups tend to be saltiest, whereas the fresh soups tend to be lower in salt … If you are concerned about how much salt you eat, try to avoid soups containing high salt ingredients such as bacon, cheese and chorizo, and instead choose vegetable- and tomato-based ones. The best option, however, would be to make your own at home.”

 

What effect does too much salt have on health?

The Food Standards Agency recommends that adults should eat no more than 6g of salt per day. The FSA estimates that the average daily intake may currently be as high as 9.5g per day (CASH estimate 8.6g). High salt levels can have a variety of effects on a person’s health. High salt can affect cardiovascular health, causing high blood pressure and increasing risk of strokes, heart disease and kidney disease.

 

How do I avoid eating too much salt?

Read the label. See how much salt there is per 100g and per serving. Take note of the serving size as well. This will be more apparent where soups are purchased in containers in supermarkets, but when purchasing in cafes and food outlets, nutritional information should be available on request.

• As was apparent from the soups that CASH surveyed, there are large variations in salt content in soups with similar flavours. Do not assume that different brands of the same type of soup have similar salt levels.
• Be aware of the salt coming from other foods, for example if soup is eaten as part of a larger meal, or if its eaten with bread, another food with typically high levels of salt. As reported by CASH, the latest National Diet Nutrition Survey (NDNS) – also published this month – showed bread to be the greatest contributor of salt to the diet, across all age groups.
• Consideration should be given to the salt levels in all packaged foods, as these often contain very high levels of salt. The FSA reports that about 75% of our salt intake is already present in the food that we buy, most of which is processed. CASH reports that cereal and cereal products (including bread) contribute 30% of the salt consumed in an adult diet, and 34-37% of that in children.

With all food, the best way of knowing how much salt is in your food is to make it yourself. However, even when cooking your own food, care should be taken regarding the salt contained in cooking items, for example in packaged meats or stocks. Another way to reduce salt is to cut down, or eliminate, any extra salt added in cooking, and add less salt at the table.

Links To The Headlines

The cartons of soup with as much salt as 16 bags of crisps. Daily Mail, February 25 2010

Soups rapped for salt content. Daily Star, February 25 2010

High levels of salt in our soup. Daily Express, February 25 2010

Shops’ soup far too salty. Daily Mirror, February 25 2010

Many soups have high salt levels, survey warns. The Guardian, February 25 2010

Warning over salt levels in soup. BBC News, February 25 2010

Links To Science

Soup survey reveals that some soups are still full of it. Consensus Action on salt and health 2010

An experimental technique has allowed a woman to successfully have two children after chemotherapy, several newspapers have reported.

The mother, Dr Stinne Bergholdt of Denmark, had part of her right ovary removed and frozen prior to chemotherapy for a rare bone cancer. Although the powerful anti-cancer drugs made her infertile, she was later able to conceive two children once the frozen tissue was thawed and re-implanted. Dr Bergholdt and her two daughters, born in 2007 and in 2008, are reported to be healthy.

This research is encouraging as it is said to be the first time that a woman has had two separate pregnancies following the transplant of “frozen and thawed” ovarian tissue. Dr Bergholdt’s doctor, Professor Claus Yding Andersen, told The Times that the result “should encourage the development of this technique as a clinical procedure for girls and young women facing treatment that could damage their ovaries”.

However, it is important to remember that this is only a single case, and questions remain over how successful or safe this technique might be for other women. Only time will tell whether further cases of ovarian tissue re-implantation will be as successful as in this interesting but very early research.

 

Where did the story come from?

This report was written by the subject of this case study, Dr Stinne Bergholdt, and her colleagues from Aarhus University Hospital, University Hospital of Odense and University Hospital of Copenhagen in Denmark. The research was funded by the Danish Cancer Foundation Grant and reported in the peer-reviewed medical journal, Human Reproduction.

This research has been accurately represented across the press.

 

What kind of research was this?

This was a case report on a mother’s two separate, successful pregnancies that occurred following the re-implantation of cryogenically preserved ovarian tissue. This tissue was frozen prior to chemotherapy, a treatment that can cause permanent infertility.

As a single case report, this research must be considered in the correct context: simply as a single case. Reports based on a single case cannot provide us with clear answers of whether the result is a one-off occurrence or whether similar results could be replicated numerous times over.

Another limitation of single case reports is that they are not able to fully inform on any possible risks or harms of experimental treatments such as ovarian tissue cryopreservation. They also cannot assess who would be the most suitable candidates for such a technique.

 

What is the background?

Dr Stinne Bergholdt was 27 years old when she was diagnosed with the rare bone cancer, Ewing’s sarcoma. She had previously had her entire left ovary removed due to an unrelated problem (a dermoid cyst). Prior to starting any chemotherapy, which would be harmful to her remaining ovary, approximately one-third of the right ovary was surgically removed in 2004. The tissue was split into 13 pieces then cryopreserved (frozen in controlled conditions). Dr Bergholdt’s cancer treatment then involved six courses of chemotherapy, surgical removal of the remaining cancerous sites and three final courses of chemotherapy.

After completion of her treatment, she had symptoms consistent with menopause. Examination of the tissue in her right ovary confirmed that following chemotherapy Dr Bergholdt had no remaining ovarian follicles (follicles can develop into mature egg cells.

Six pieces of ovarian tissue (around 15–20% of an entire ovary) were thawed and then re-implanted into Dr Bergholdt’s remaining right ovary in December 2005.

 

What was the outcome?

After re-implantation, Dr Bergholdt’s hormone levels began to climb back to pre-menopausal levels. Dr Bergholdt conceived her first daughter following a form of mild ovarian stimulation that encourages the ovary to release mature eggs. The first healthy baby girl was born by caesarean section on 8 February 2007. The mother returned to the fertility clinic in January 2008 for IVF treatment. However, a pregnancy test revealed that she had naturally conceived again.

After a second complication-free pregnancy, the second healthy baby girl was delivered on 23 September 2008. At the time of writing this case report (a full four years after re-implantation) the ovarian tissue remained functional.

 

How did the researchers interpret the results?

The authors say this is the first case of a woman giving birth to two healthy children from two separate pregnancies following re-implantation of frozen then thawed ovarian tissue. The results showed that, in a woman who had experienced a chemotherapy-induced menopause, just 15–20% of one ovary could result in the production of fully mature egg cells for a period exceeding four years and that “the capacity to give birth to healthy children remains”.

 

Conclusion

As the authors say, this recent success raises the number of children born as a result of re-implanting frozen then thawed ovarian tissue to nine, globally. Six were conceived with the help of IVF and three conceived naturally. This is undoubtedly encouraging news but it remains a very small number of cases.

Given the extremely small number of women that have given birth using this technique, many questions remain over which women would be the most suitable candidates and which would be most likely to achieve success. Further research is needed to establish how successful further ovarian re-transplants are in a greater number of women and whether there are any adverse health risks to the mother or the child. There is no indication in this report of how many additional women have previously been unsuccessfully treated, alongside the successes.

As Dr Melanie Davies, a spokesperson for the Royal College of Obstetricians and Gynaecologists, says, this is “very encouraging news” but it is still ‘early days’. However, given the importance of preserving the fertility of chemotherapy patients, this technique will undoubtedly be the focus of larger studies in the future. These may be able to answer some of the important questions that surround new experimental treatments and provide a fuller picture of the potential of this technology.

Links To The Headlines

Mother has second child after ovary transplant. BBC News, February 25 2010

Second baby after ovary transplant is a world first. The Independent, February 25 2010

Second baby for former cancer patient after tissue transplant. The Times, February 25 2010

‘Miracle’ second baby for ovarian transplant woman. The Daily Telegraph, February 25 2010

Ovary transplant mum’s joy as she has miracle-baby. Daily Express, February 25 2010

Links To Science

Ernst E, Bergholdt S, Jørgensen JS, and Andersen CY The first woman to give birth to two children following transplantation of frozen/thawed ovarian tissue. Human Reproduction, [Press release] February 25 2010

“Women who conceive using fertility treatment run a fourfold higher risk of a stillbirth”, the Daily Mail reported. The newspaper said that researchers have warned that women who conceive using in vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI) were at increased risk compared to women getting pregnant naturally or using other assisted reproductive treatments.

This study did find that the risk of stillbirth was four times greater for these women than those not receiving these IVF treatments. However, the newspaper does not sufficiently emphasise that the absolute risk was still small. Overall, the absolute risk for both naturally and non-IVF assisted conceptions was 4.3 stillbirths per 1000 pregnancies. The risk with IVF and ICSI was 16.2 per thousand meaning, meaning that these techniques raised the risk by 11.9 per 1000 or about 1%. As such, one extra woman in a hundred may experience a stillbirth following these techniques who otherwise would not have done.

The findings are confounded by the fact that women receiving IVF or ICSI may be at increased risk of stillbirths due to factors such as their age. The researchers attempted to adjust for some of these factors, but unmeasured variables cannot be ruled out.

Overall, on its own this study does not completely settle the uncertainty as to whether IVF or ICSI poses an increased risk of stillbirth. What is known is that multiple birth pregnancies are the single biggest risk of fertility treatment and, as the researchers say, twins face an increased risk of preterm birth, low birthweight, and serious health problems. Where possible, couples undergoing IVF should be encouraged to opt for single embryo transfer in order to reduce the risk of multiple birth pregnancy.

 

Where did the story come from?

This research was conducted by Dr Kirsten Wisborg and colleagues from the Perinatal Epidemiology Research Unit at Aarhus University Hospital in Denmark, and supported by grants from the Dagmar Marshall’s Fund.  The study was published in the peer-reviewed medical journal Human Reproduction.

The Daily Mail and other newspapers add some balance to the debate by quoting the authors of similar studies in the field. One larger study in more than 27,000 women having IVF in Sweden compared outcomes from pregnancies after IVF/ICSI with a control group of 2,603,601 spontaneous pregnancies. In contrast to today’s study, no increase in stillbirths from IVF/ICSI treatment in this larger group was found.

 

What kind of research was this?

This research used data from a prospective cohort study called the Aarhus Birth Cohort. This analysis of the study data compared the risk of stillbirth in women who had conceived for the first time after fertility treatment, subfertile women (who conceive after a year of trying), and fertile women. To be included, the women had to have had a singleton pregnancy (pregnant with a one baby). The fertility treatment included In-vitro fertilisation (IVF), intracytoplasmic sperm injection (ICSI) and this was compared with non-IVF assisted reproductive technology (ART).

The Aarhus Birth Cohort routinely included information on all single baby pregnancies and births in the town of Aarhus in Denmark from 1989 to 2006. In this data set of over 20,000 pregnancies, the researchers were able to count and compare the number of stillbirths that occurred in women using a variety of non-IVF ART.

One aspect of this analysis showed that women who conceived after IVF/ICSI had higher stillbirth rates compared to rates in women who conceived after non-IVF ART. This association was present after other factors thought to also influence risk of stillbirth were taken into account. However, women with assisted pregnancies do differ from other women in ways that affect risk of stillbirth, for example in the number of children they have already had, age, other diseases and smoking.

Although, the adjustment to the analysis suggests that none of these factors fully explain the results, other unknown factors might and these cannot be ruled out. In addition, other studies have had contradictory results to these, suggesting more research is needed.

 

What did the research involve?

The researchers explain that it is not known if babies (singletons) conceived through ART have a higher risk of being stillborn as previous research has not fully accounted for important factors that can potentially influence the risk. They say it is particularly important to establish whether it is the fertility treatment, the possible reproductive pathology (why couples are having problems conceiving) of the infertile couples who take it, or other characteristics related to being subfertile that explain any link.

For example, multiple pregnancy (twins and triplets) is an established risk. Although they chose to study only singletons to avoid this possibility, but the researchers also acknowledge that up to 10% of IVF single baby deliveries are the result of twin pregnancies in which one early embryo may have failed to develop.

In this study in Aarhus from 1989 to 2006, women booked for delivery, and who agreed to participate (75% of those asked), completed two questionnaires before the first routine antenatal care visit at 16 weeks into the pregnancy. Together, the two questionnaires collected data on medical and obstetric history, waiting time to pregnancy and fertility treatment, age, smoking habits and alcohol intake during pregnancy, coffee intake, marital status, education and any psychological problems.

The researchers included only women with first time pregnancies and single baby deliveries who filled in the first questionnaire (27, 072 women). They excluded 4,268 women with chronic illnesses (such as heart, lung, kidney diseases, diabetes, other metabolic diseases or epilepsy) and 2,638 women with missing information on waiting time to pregnancy and infertility treatment. They analysed the data appropriately using a technique called multivariate logistic regression analysis.

 

What were the basic results?

From a total 20,166 first-time singleton pregnancies, 82% conceived spontaneously within a year of trying, and 10% conceived after more than a year of trying (classified as sub-fertile). There were 879 pregnancies (4%) as a result of non-IVF fertility treatment and 742 (4%) after IVF/ICSI.

There were a total of 86 stillbirths, making the overall risk of stillbirth, 4.3 stillbirths per 1000 pregnancies. The risk of stillbirth in women who conceived after IVF/ICSI was 16.2 per 1000. The chance of a stillbirth was therefore about four times greater in the IVF/ICSI group after taking into account maternal age, education, marital status, body mass index and intrauterine exposure to tobacco smoke, alcohol and coffee (odds ratio [OR] 4.08, 95% confidence interval [CI] 2.11 to 7.93).

When the researchers did not adjust for any of these factors, the rate was higher (OR 4.44, 95% CI 2.38 to 8.28) showing that these are only partly explaining the increased risk.

 

How did the researchers interpret the results?

The researchers say that compared with fertile women, women who conceived by IVF/ICSI had an increased risk of stillbirth that was not explained by confounding (other factors they recorded that could have influenced the results).

They say their results indicate that the “increased risk of stillbirth seen after fertility treatment is a result of the fertility treatment or unknown factors pertaining to couples who undergo IVF/ICSI”.

 

Conclusion

This well-designed prospective study collected a lot of data routinely and followed women through pregnancy until delivery. The researchers note several points of caution:

• In support of the argument that the increased risk of stillbirth is due to the ART technique and not explained by infertility, the researchers say they found that couples with a waiting time to pregnancy of one year or more and women who conceived after non-IVF ART had a risk of stillbirth similar to that of fertile couples. This may indicate that the increased risk of stillbirth is not explained by infertility.
• For some confounding factors, the researchers used categories (such as smoking no/yes) instead of counting the number of cigarettes smoked. This may mean that these factors were not fully adjusted for. There may also be unknown reasons for infertility that were not captured in their questionnaire.
• The ‘vanishing twins’ could have accounted for some of the increase in stillbirths.. This is a pregnancy where there were initially two embryos (a twin pregnancy), but as one fails to develop there is just a single baby birth. If these pregnancies took on the risk of multiple births, it could be an explanation of the increased risk. However, the researchers say this is probably not the sole contributor to the increased risk of stillbirth in IVF singletons as the number of ‘vanishing twins’ is small.

Overall, on its own this study does not completely settle the uncertainty as to whether IVF or ICSI poses an increased risk of stillbirth. What is known is that multiple pregnancy remains the single biggest risk of fertility treatment and as the researchers say twins face an increased risk of preterm birth, low birth weight, and serious health problems. Where possible, couples undergoing IVF should be encouraged to opt for single embryo transfer in order to reduce the risk of multiple birth pregnancies.

It should be remembered that despite this study finding the risk of stillbirth is increased fourfold for couples receiving assistance, the overall risk of stillbirth is actually low. This study found the overall risk of stillbirth in women who had not had IVF or ICSI to be 4.3 per 1000 pregnancies.

Links To The Headlines

Still births four times more likely with IVF. The Guardian, February 24 2010

Concerns raised over IVF stillbirth risk. The Daily Telegraph, February 24 2010

Risk of stillbirth increases fourfold in women using fertility treatment. Daily Mail, February 24 2010

‘IVF creates higher risk of stillbirth’. Daily Mirror, February 24 2010

Links To Science

Wisborg K, Ingerslev HJ, and Henriksen TB. IVF and stillbirth: a prospective follow-up study. Human Reproduction 2010